"As has long been demonstrated by Kaiser Permanente, when the delivery and financing of healthcare are integrated it is possible to offer high-value, innovative services that are otherwise less feasible. Integrated delivery systems are able to invest in services that improve quality and lower costs, but may not be billable using conventional fee-for-service means. As the insurer arm of an integrated delivery system can capture the savings from unbillable provider services the services can be financially justified."
Powell, president of Boston-based consultants Payer+Provider Inc., says that North Shore-LIJ can use CareConnect to increase the size of its patient population.
"Patients covered by the health plan are steered towards North Shore-LIJ providers," he says. "As the health system works toward treating more patients under value-based payment arrangements it has invested in developing the capabilities necessary to manage risk and keep patients out of the hospital. By running a health plan, North Shore-LIJ increases its ability to financially benefit from the risk management capabilities that it already must develop."
Alan Murray, vice president of managed care at North Shore-LIJ says CareConnect "signals a different way for health insurers and providers to work together."